This month’s story follows a husband and wife navigating one of the more confusing and emotionally complex aspects of Alzheimer’s disease: when a person begins to live in an earlier version of their life.
“Theresa” has been living with Alzheimer’s disease for 11 years and is now in the moderate stage. Over time, her memory has shifted backwards in time. Instead of moving smoothly through past and present, she often seems to live in the earlier chapters of her life.
At night, Theresa’s husband, “Bernie,” notices something particularly heartbreaking: Theresa no longer recognizes him as her husband. Instead, she asks for her parents and speaks as though she is a “teenager.”
This is not unusual in dementia. Nevertheless, it is always deeply disorienting for families.
When the Present No Longer Feels Familiar
In the evenings, when it is time to get ready for bed, Bernie lays out Theresa’s night clothes as part of their routine. On many occasions, she refuses to change and insists on wearing her daytime clothing to bed.
From a caregiving perspective, this can feel confusing and even frustrating. What seems like a simple routine task becomes a moment of resistance.
Bernie tried a creative approach we had suggested that might work given Theresa’s current reality. Knowing how close Theresa was to her mother, we suggested that Bernie say:
“Your mom has gone home. She’s tired. It’s time to get ready for bed, but she’ll see you in the morning.”
For a long time, this approach worked. The gentle reminder that her loving mother has gone home for the night and is returning in the morning gave Theresa the gentle reassurance she needed – that she would see her Mom when she wakes up in the morning.
But recently, something shifted again.
Theresa became more resistant to Bernie. She started insisting on wearing her daytime clothes for bed – a behaviour not unusual in the moderate stages of Alzheimer’s disease. It became clear that another layer needed to be understood.
Understanding the Meaning Behind the Behaviour
In Alzheimer’s disease, especially in moderate stages, the brain’s ability to organize time becomes disrupted. Instead of a clear sense of “today, yesterday, and tomorrow,” many individuals experience what is often described as “retrogenesis” – a reverse developmental decline, often seen in Alzheimer’s as a “return to childhood.”
In these cases, people appear to “go back in time,” not metaphorically, but in the way their brain retrieves and organizes memory.
Theresa is not simply forgetting.
She is experiencing reality through an earlier life stage where:
- Her parents are still central figures
- Her sense of independence is different
- Her husband (Bernie) may no longer be recognized in the same relational role
- Authority and comfort are more strongly linked to parental figures
When Bernie gives instructions, Theresa does not always interpret them as coming from a trusted spouse. In her current cognitive reality, he may feel unfamiliar.
But when the suggestion is reframed through her mother – someone deeply familiar, emotionally significant, and trusted – the message feels safe and easier to accept, such as, “Your mother is suggesting you wear this to bed tonight.”
Why This Strategy Works
This approach aligns with what we understand about Alzheimer’s disease progression and memory processing:
- Recent memory is more affected than older emotional memory
- Procedural and emotional memories (like trust in a parent) are often preserved longer
- The brain may rely on earlier autobiographical “maps” when current ones are no longer accessible
- Identity and relationships can regress to earlier life stages
Bernie is using a person-centred approach by not correcting Theresa’s reality but by entering it. In doing so, he reduces distress and increases cooperation without confrontation.
The Simple Solution to Supporting with Compassion and Flexibility
Care partners often feel pressure to “bring someone back to the present.” But in dementia care, repeated correction can sometimes increase confusion or resistance.
Instead, Bernie’s experience highlights several supportive approaches:
- Accept the current emotional reality rather than correcting factual inaccuracies
- Use familiar and trusted figures (like a parent) to guide cooperation
- Maintain calm, simple, and emotionally safe communication
- Avoid confrontation when resistance is rooted in confusion, not defiance
- Adapt language based on what the person still recognizes and values
- Focus on comfort and dignity rather than compliance
- Seek help and support from experts when needed
In dementia care, there is often a natural urge to correct and reorient someone to the present. Yet experience shows that connection is often more important than correction.
When we focus on understanding the emotion behind a response, rather than the accuracy of the words, we are better able to respond in ways that reduce distress and preserve dignity. Small shifts: using familiar language, staying calm, and meeting the person where they are can make everyday moments feel safer and more meaningful.
In doing so, we remind ourselves that care is not about control, but about compassion, patience, and support through each changing moment.
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DISCLAIMER:
This article is based on a true story; however, names, locations, and certain events have been altered to protect the privacy and confidentiality of the individuals involved. Any resemblance to actual persons, living or dead, or actual events is purely coincidental.
The contents of this blog are provided for information purposes only. They are not intended to replace clinical diagnosis or medical advice from a health professional.
